WASHINGTON AND JANE SMITH COMMUNITY BEVERLY: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
WASHINGTON AND JANE SMITH COMMUNITY BEVERLY (EIN 36-2167948)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-02-14
IRS object ID
201410459349302311
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-02-14T14:25:58-06:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN410746749EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11301 W 22ND ST SUITE 1100AddressLine1
CityOAK BROOKCity
StateILState
ZIP Code60523ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN362167948EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1WASHINGTON AND JANE SMITH COMMUNITY - BEVERLYBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlWASHNameControl
Phone7734747300Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12320 WEST 113TH PLACEAddressLine1
CityCHICAGOCity
StateILState
ZIP Code60643ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameRAY MARNERISName
TitleCFOTitle
Phone7734747350Phone
Date Signed2014-02-07DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameGREGORY S ADAMSName
PTINP00095597PTIN
Phone6305738600Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1SMITH VILLAGEBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonKEVIN MCGEENameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12320 WEST 113TH PLACEAddressLine1
CityCHICAGOCity
StateILState
ZIP Code60643ZIPCode
FieldValueIRS element (for citing)
Gross Receipts19763360GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.SMITHVILLAGE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1926YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionTHE MISSION OF SMITH VILLAGE IS TO ENRICH THE LIVES OF SENIOR ADULTS. (SEE SCHEDULE O) THROUGH THE OPERATION OF A CONTINUING CARE RETIREMENT COMMUNITY OFFERING THE HIGHEST QUALITY OF SERVICES.ActivityOrMissionDescription
Nbr Voting Members Governing Body6NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees306TotalNbrEmployees
Total Nbr Volunteers318TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year579840ContributionsGrantsPriorYear
Contributions Grants Current Year634745ContributionsGrantsCurrentYear
Program Service Revenue Prior Year17962469ProgramServiceRevenuePriorYear
Program Service Revenue CY18230647ProgramServiceRevenueCY
Investment Income Prior Year498014InvestmentIncomePriorYear
Investment Income Current Year105799InvestmentIncomeCurrentYear
Other Revenue Prior Year126944OtherRevenuePriorYear
Other Revenue Current Year93059OtherRevenueCurrentYear
Total Revenue Prior Year19167267TotalRevenuePriorYear
Total Revenue Current Year19064250TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year400611GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY269694GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year6005065SalariesEtcPriorYear
Salaries Etc Current Year5541339SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year13196507OtherExpensePriorYear
Other Expenses Current Year14176600OtherExpensesCurrentYear
Total Expenses Prior Year19602183TotalExpensesPriorYear
Total Expenses Current Year19987633TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-434916RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-923383RevenuesLessExpensesCY
Total Assets BOY72134138TotalAssetsBOY
Total Assets EOY71219102TotalAssetsEOY
Total Liabilities BOY71349697TotalLiabilitiesBOY
Total Liabilities EOY71405828TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY784441NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-186726NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSMITH VILLAGE WAS INCORPORATED FOR THE CHARITABLE PURPOSE OF PROVIDING INDEPENDENT LIVING, ASSISTED LIVING, AND NURSING CARE SERVICES TO MEN AND WOMEN THROUGH THE OPERATION OF A CONTINUING CARE RETIREMENT COMMUNITY. (SEE SCHEDULE O) LOCATED IN BEVERLY, ILLINOIS. WITHIN THE COMMUNITY, SMITH VILLAGE OPERATES A 152 INDEPENDENT LIVING UNITS, 82 BED ASSISTED LIVING, 39 BED SKILLED MEMORY SUPPORT, AND 61 BED SKILLED NURSING FACILITY LICENSED BY THE ILLINOIS DEPARTMENT OF PUBLIC HEALTH (IDPH). ALL 100 SKILLED NURSING BEDS ARE CERTIFIED FOR PARTICIPATION IN THE MEDICARE AND MEDICAID PROGRAMS. SMITH VILLAGE IS SUBJECT TO PERIODIC REGULATORY INSPECTIONS PERFORMED BY IDPH.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense8005721Expense
Revenue8349372Revenue
DescriptionTHE ORGANIZATION PROVIDES RETIREMENT HOUSING AND HEALTH CARE SERVICES TO SENIOR ADULTS IN A CONTINUING CARE RETIREMENT COMMUNITY SETTING. SMITH VILLAGE OPERATES A 100 BED SKILLED NURSING CARE UNIT. SERVICES PROVIDED INCLUDE 24-HOUR NURSING CARE AND REHABILITATION SERVICES. ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS WERE $578,134 OF SERVICES FOR THESE TWO GOVERNMENTAL SPONSORED PROGRAMS. THE COMMUNITY ALSO PROVIDED $312,257 IN HEALTH CARE DISCOUNTS TO ITS RESIDENTS.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense5642303Expense
Revenue3640380Revenue
DescriptionTHE ORGANIZATION PROVIDES RETIREMENT HOUSING AND HEALTH CARE SERVICES TO SENIORS AGED 62 AND OLDER IN A CONTINUING CARE RETIREMENT COMMUNITY SETTING. WITHIN THE COMMUNITY, SMITH VILLAGE OPERATES 152 INDEPENDENT LIVING APARTMENTS. SMITH VILLAGE BEGAN OPERATION OF THESE UNITS IN NOVEMBER 2007. RESIDENTS RECEIVE DISCOUNTED SERVICES IN HEALTHCARE SHOULD THEY REQUIRE TRANSITION TO ASSISTED LIVING OR INTO SKILLED CARE. RESIDENTS WHO OUTLIVE THEIR FINANCIAL RESOURCES CAN APPLY FOR SUPPORT THROUGH THE CHARITABLE CARE FUNDS OF SMITH VILLAGE.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense4078646Expense
Grants269694Grants
Revenue4069563Revenue
DescriptionTHE ORGANIZATION PROVIDES RETIREMENT HOUSING AND HEALTH CARE SERVICES TO SENIORS AGED 55 AND OLDER IN A CONTINUING CARE RETIREMENT COMMUNITY SETTING. SMITH VILLAGE OPERATES A 82 UNIT ASSISTED LIVING CENTER. SERVICES INCLUDE PROVISION OF ASSISTANCE TO INDIVIDUALS WHO CAN NO LONGER LIVE INDEPENDENTLY AND NEED ASSISTANCE WITH AT LEAST THREE ACTIVITIES OF DAILY LIVING SUCH AS EATING, BATHING, DRESSING, MEDICATIONS, ETC. INDIVIDUALS RESIDING IN ASSISTED LIVING WHO HAVE OUTLIVED THEIR FINANCIAL RESOURCES ARE FURTHER SUPPORTED BY THE CHARITABLE CARE FUNDS OF SMITH VILLAGE. DURING FYE 2013, $269,694 IN CHARITABLE SERVICES WERE PROVIDED TO RESIDENTS IN ASSISTED LIVING.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Revenue2236734Revenue
FieldValueIRS element (for citing)
Total Of Other Program Service Rev2236734TotalOfOtherProgramServiceRev
Total Program Service Expense17726670TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling1CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds1InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109624NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees306NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members6NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1RAY MARNERISBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7734747350TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12320 WEST 113TH PLACEAddressLine1
CityCHICAGOCity
StateILState
ZIP Code60643ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (9 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
ALLEN K FLAGLER
TRUSTEE1.001.00X000
THOMAS L HOGAN
TRUSTEE1.001.00X000
STEVEN J MURPHY
VICE CHAIR2.002.00X000X
KARYN PETTIGREW
TRUSTEE1.001.00X000
WILLIAM H HUNDING
BOARD CHAIR3.003.00X000X
HUGH J AHERN
TRUSTEE1.002.00X000
RAYMOND J MARNERIS
TREASURER/CFO12.0037.50013261827668X
KEVIN MCGEE
PRESIDENT/CEO12.0037.50776096213830269X
EDUARDO TORRES
DIRECTOR OF NURSING37.500.0012372705208X
FieldValueIRS element (for citing)
Total Reportable Comp From Org201336TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs194756TotalReportableCompFrmRltdOrgs
Total Other Compensation63145TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
WASHINGTON & JANE SMITH HOME
2320 W 113TH PLACECHICAGOIL60643NURSING SERVICES2182661
MORRISON SENIOR DINING
PO BOX 102289ATLANTAGA30268DINING SERVICES1776545
WASHINGTON & JANE SMITH HOME
2320 W 113TH PLACECHICAGOIL60643MANAGEMENT SERVICES1666568
ALLIANCE REHAB
1520 KENSINGTON ROADOAKBROOKIL60523CONTRACT REHAB SERVICES827627
ALLIANCE PHARMACY
1520 KENSINGTON ROADOAKBROOKIL60523CONTRACT PHARMACY173689
FieldValueIRS element (for citing)
Number Of Contractors GT100 K7NumberOfContractorsGT100K
Related Organizations462252RelatedOrganizations
All Other Contributions172493AllOtherContributions
Total Contributions634745TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NURSING CARE SERVICES62300083493728349372
ASSISTED LIVING SERVCES62300040695634069563
INDEPENDENT LIVING SERVICES62300036403803640380
ANCILLARY SERVICES62300013743191374319
ENTRANCE FEES RECOGNIZED623000553438553438

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column243575TotalRevenueColumn
Related Or Exempt Function Income243575RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue18230647TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column99548TotalRevenueColumn
Exclusion$99,548ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column-15656TotalRevenueColumn
Exclusion-$15,656ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real188221Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real95162Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real93059Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column93059TotalRevenueColumn
Related Or Exempt Function Income65402RelatedOrExemptFunctionIncome
Exclusion$27,657ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities625855Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities603948Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities21907Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column21907TotalRevenueColumn
Exclusion$21,907ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column19064250TotalRevenueColumn
Related Or Exempt Function Income18296049RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$133,456ExclusionAmount

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total269694Total
Program Services269694ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total167597Total
Program Services167597ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4396555Total
Program Services4396555ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total57275Total
Program Services57275ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total583438Total
Program Services583438ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total336474Total
Program Services336474ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1666568Total
Management And General1666568ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total69897Total
Program Services69897ProgramServices

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total8689Total
Management And General8689ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total5651820Total
Program Services5334065ProgramServices
Management And General317755ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total193531Total
Program Services24949ProgramServices
Management And General168582ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total355377Total
Program Services283270ProgramServices
Management And General72107ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total28628Total
Program Services12253ProgramServices
Management And General16375ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total962022Total
Program Services962022ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total27464Total
Program Services18781ProgramServices
Management And General8683ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total2333104Total
Program Services2333104ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2586609Total
Program Services2586609ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total141667Total
Program Services139463ProgramServices
Management And General2204ManagementAndGeneral

Other Expenses OtherExpenses

FieldValueIRS element (for citing)
DescriptionTAXES AND FEESDescription
Total151224Total
Program Services151224ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total19987633Total
Program Services17726670ProgramServices
Management And General2260963ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY500BOY
EOY500EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY978115BOY
EOY673781EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY918630BOY
EOY1028501EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY81228BOY
EOY106336EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis71725077LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec15226226LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY58230471BOY
EOY56498851EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY3499838BOY
EOY5917673EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY4781968BOY
EOY4495154EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3643388BOY
EOY2498306EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY72134138BOY
EOY71219102EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2697068BOY
EOY2608748EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY1662746BOY
EOY1501159EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY38867323BOY
EOY38130508EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY256444BOY
EOY367350EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY27866116BOY
EOY28798063EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY71349697BOY
EOY71405828EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY724825BOY
EOY-247810EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY59616BOY
EOY61084EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY784441BOY
EOY-186726EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY72134138BOY
EOY71219102EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-923383ReconcilationRevenueExpenses
Reconciliation Unrealized Invest-49252ReconciliationUnrealizedInvest
Reconcilation Other Changes1468ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years661412CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years587517CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years711632CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year579840CurrentTaxYearMinus1Year
Current Tax Year634745CurrentTaxYear
Total3175146Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years12778937CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years14236810CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years17644749CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year17962469CurrentTaxYearMinus1Year
Current Tax Year18364328CurrentTaxYear
Total80987293Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years13440349CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years14824327CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years18356381CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year18542309CurrentTaxYearMinus1Year
Current Tax Year18999073CurrentTaxYear
Total84162439Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years413248CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years459114CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years463548CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year434403CurrentTaxYearMinus1Year
Current Tax Year542737CurrentTaxYear
Total2313050Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years413248CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years459114CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years463548CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year434403CurrentTaxYearMinus1Year
Current Tax Year542737CurrentTaxYear
Total2313050Total
FieldValueIRS element (for citing)
Public Support Total50981849389PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years192554CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years220365CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years222730CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year432210CurrentTaxYearMinus1Year
Current Tax Year138432CurrentTaxYear
Total1206291Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years192554CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years220365CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years222730CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year432210CurrentTaxYearMinus1Year
Current Tax Year138432CurrentTaxYear
Total1206291Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years64519CurrentTaxYearMinus4Years
Current Tax Year21907CurrentTaxYear
Total86426Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years13697422CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years15044692CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years18579111CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year18974519CurrentTaxYearMinus1Year
Current Tax Year19159412CurrentTaxYear
Total85455156Total
FieldValueIRS element (for citing)
Public Support Percentage5090.95780PublicSupportPercentage509
Prior Year Support Percentage0.94770PriorYearSupportPercentage
Investment Income Percentage0.01410InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.02120PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$7,739OtherActivitiesAmount
Total Lobbying Expenditures IIB7739TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationTHE EXPENSES DETAILED ABOVE REPRESENT AN ALLOCATION OF MEMBERSHIP DUES TO LSN ASSOCIATION.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtc
Included On FS1IncludedOnFS
Explanation In Part XIIIXExplanationInPartXIII

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance11505438BeginningOfYearBalance
Investment Earnings Or Losses1104546InvestmentEarningsOrLosses
Grants Or Scholarships462252GrantsOrScholarships
Other Expenditures67558OtherExpenditures
End Of Year Balance12080174EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance11903799BeginningOfYearBalance
Investment Earnings Or Losses85920InvestmentEarningsOrLosses
Grants Or Scholarships434403GrantsOrScholarships
Other Expenditures121962OtherExpenditures
End Of Year Balance11433354EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance10274728BeginningOfYearBalance
Investment Earnings Or Losses2092619InvestmentEarningsOrLosses
Grants Or Scholarships463548GrantsOrScholarships
End Of Year Balance11903799EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance9837732BeginningOfYearBalance
Investment Earnings Or Losses870994InvestmentEarningsOrLosses
Grants Or Scholarships418398GrantsOrScholarships
End Of Year Balance10290328EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance10661483BeginningOfYearBalance
Investment Earnings Or Losses418068InvestmentEarningsOrLosses
Grants Or Scholarships405683GrantsOrScholarships
End Of Year Balance10673868EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance0.07000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.93000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1674140OtherCostOrOtherBasis
Book Value1674140BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis66070703OtherCostOrOtherBasis
Depreciation13054539Depreciation
Book Value53016164BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis3931234OtherCostOrOtherBasis
Depreciation2171687Depreciation
Book Value1759547BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis49000OtherCostOrOtherBasis
Book Value49000BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings56498851TotalOfBookValueLandBuildings

Other Securities OtherSecurities (3 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
FIXED INCOME - GICS3009063F
FIXED INCOME - MUTUAL FUNDS123931F
CASH1362160F
FieldValueIRS element (for citing)
Total Of Book Value Securities4495154TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
REFUNDABLE ENTRANCE FEES$21,096,881
OTHER CURRENT LIABILITIES$1,791
REFUNDABLE RESERVATION DEPOSITS$726,832
NOTE PAYABLE TO AFFILIATE$6,972,559
FieldValueIRS element (for citing)
Total Of Amounts28798063TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt18840466TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-49252NetUnrealizedGainsInvestments
Other Revenues95162OtherRevenues
Revenue Not Rptd F99045910RevenueNotRptdF990
Revenue Subtotal18794556RevenueSubtotal
Other Revenues Not Included269694OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt269694RevenueNotRptdOnFinStmt
Total Revenue Per Form99019064250TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt19813101TotExpensesEtcAuditedFinclStmt
Other Expenses Included95162OtherExpensesIncluded
Expenses Not Rptd F99095162ExpensesNotRptdF990
Expenses Subtotal19717939ExpensesSubtotal
Other Expenses Not Included269694OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt269694ExpensesNotRptdOnFinStmt
Total Expenses Per Form99019987633TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART IV, LINE 2B:RESIDENTS CAN ELECT TO USE THE ORGANIZATION FOR THE MANAGEMENT OF THEIR FUNDS THROUGH THE RESIDENT TRUST ACCOUNTS. THERE IS NO UPPER LIMIT ON AMOUNTS THAT CAN BE ACCEPTED. RESIDENTS AUTHORIZE THE ORGANIZATION TO UTILIZE THEIR FUNDS TO PAY FOR ITEMS AS NEEDED. ALL FUNDS ARE HELD SEPARATELY FROM CORPORATE FUNDS, BUT COMMINGLED WITH OTHER RESIDENTS' FUNDS. INTEREST IS PAID ON A PASS-THROUGH BASIS FROM BANKING INSTITUTIONS. NO ADDITIONAL FEES ARE INCURRED FOR RESIDENTS TO UTILIZE THIS TRUST FUND ARRANGEMENT.
PART V, LINE 4:THE ENDOWMENT FUND IS HELD BY WASHINGTON AND JANE SMITH HOME D/B/A SMITH SENIOR LIVING (SSL), A RELATED TAX-EXEMPT ORGANIZATION. SSL DISBURSES FUNDS AS NEEDED WITHIN THE GUIDELINES OF THE ENDOWMWNT FUND. THE EARNINGS ON THE ASSETS OF THE ENDOWMENT FUND HAVE BEEN DESIGNATED TO SUPPORT THE CHARITABLE CARE ACTIVITIES OF SMITH VILLAGE.DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:
PART X, LINE 2:THE ORGANIZATION QUALIFIES AS A TAX-EXEMPT CORPORATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE IRC. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, ALL YEARS SINCE INCEPTION COULD BE SUBJECT TO REVIEW BY THE INTERNAL REVENUE SERVICE (IRS). THE FEDERAL AND STATE TAX RETURNS FOR THE ORGANIZATION FOR 2010, 2011, AND 2012 FISCAL YEARS ARE SUBJECT TO EXAMINATION BY THE IRS AND STATE TAXING AUTHORITIES, GENERALLY FOR THREE YEARS AFTER THE DATE THEY WERE FILED.DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:
RENTAL REVENUE EXPENSES 95,162.PART XI, LINE 2D - OTHER ADJUSTMENTS:
CHARITABLE CARE 269,694.PART XI, LINE 4B - OTHER ADJUSTMENTS:
RENTAL REVENUE EXPENSES 95,162.PART XII, LINE 2D - OTHER ADJUSTMENTS:
CHARITABLE CARE 269,694.PART XII, LINE 4B - OTHER ADJUSTMENTS:

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantCHARITABLE CARETypeOfGrant
Number Of Recipients7NumberOfRecipients
Amount Of Cash Grant269694AmountOfCashGrant
Method Of ValuationN/AMethodOfValuation
Description Of Non Cash AssistanceN/ADescriptionOfNonCashAssistance

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: THE ORGANIZATION'S CHARITABLE SUPPORT PROGRAM HAS TWO COMPONENTS. IN SEVERAL INSTANCES, THE ORGANIZATION HAS AGREED TO PROVIDE A FIXED AMOUNT PER MONTH IN CHARITABLE SUPPORT WITH THE EXPECTATION THAT THE INDIVIDUAL IS THEN RESPONSIBLE FOR THE BALANCE OF THEIR MONTHLY BILL. THE SECOND COMPONENT DESIGN IS WHEN AN INDIVIDUAL HAS ESSENTIALLY RUN OUT OF ASSETS AND THE ORGANIZATION CONTINUES TO PROVIDE ALL THE REQUIRED SERVICES WITH CHARITABLE CARE.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
RAYMOND J MARNERIS
TREASURER/CFO01191760001344205658022010016028600
KEVIN MCGEE
PRESIDENT/CEO6860156008009008613029782452170977742976847233200

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 3ReturnReference
ExplanationTHE ORGANIZATION RELIES ON SMITH SENIOR LIVING (SSL), A RELATED TAX-EXEMPT ORGANIZATION TO DETERMINE THE COMPENSATION OF THE ORGANIZATIONS TOP MANAGEMENT OFFICIALS. THE COMPENSATION COMMITTEE OF SSL EVALUATES AND ESTABLISHES COMPENSATION AND REVIEWS PROTOCOL FOR THE ORGANIZATIONS CEO AND CFO. ANNUAL COMPENSATION COMPARISONS TO INDUSTRY PROFESSIONALS ARE GATHERED AND REVIEWED ON AN ANNUAL BASIS. DECISIONS ARE DOCUMENTED IN THE COMPENSATION COMMITTEE MEETING MINUTES.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1ILLINOIS FINANCE AUTHORITYBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN861091967IssuerEIN
CUSIP Number45200BVN5CUSIPNumber
Date Issued2005-12-29DateIssued
Issue Price61805000IssuePrice
Description Of PurposeRE-DEVELOPED CAMPUS INTO A CCRCDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Amount Retired23905000AmountRetired
Total Proceeds63046169TotalProceeds
Amount In Reserve Fund4495154AmountInReserveFund
Capitalized Interest3706008CapitalizedInterest
Issuance Costs From Proceeds1111028IssuanceCostsFromProceeds
Credit Enhancement250181CreditEnhancement
Capital Expenditures47790073CapitalExpenditures
Other Spent Proceeds5549027OtherSpentProceeds
Year Of Subst Completion2006YearOfSubstCompletion
Current Refunding1CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements1AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty1MngmentCntrctBondFinancdPrprty
Engage Bond Counsel Contracts1EngageBondCounselContracts
Any Research Agreements0AnyResearchAgreements
Prcntge Prvt Business Use By Others0.00360PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00360TotalPrivateBusinessUse
Bond Iss Meet Prvt Security Pay Test1BondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed Prop0ChangeInUseBondFinancedProp
Non Qualified Bond Remed Procdrs1NonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiled
Rebate Not Due Yet0RebateNotDueYet
Exception To Rebate0ExceptionToRebate
No Rebate Due1NoRebateDue
Variable Rate Issue1VariableRateIssue
Hedge Identified In Books And Recds1HedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

FieldValueIRS element (for citing)
Business Name Line1LASALLE BANKBusinessNameLine1
Business Name Line2NATIONALBusinessNameLine2
FieldValueIRS element (for citing)
Term Of Hedge4.000000000000TermOfHedge
Superintegrated Hedge0SuperintegratedHedge
Hedge Terminated0HedgeTerminated
Gross Proceeds Invested In GIC1GrossProceedsInvestedInGIC

Name Of GIC Provider NameOfGICProvider

FieldValueIRS element (for citing)
Business Name Line1NATIXISBusinessNameLine1
FieldValueIRS element (for citing)
Term Of GIC40.000000000000TermOfGIC
Regulatory Safe Harbor Satisfied1RegulatorySafeHarborSatisfied
Written Proc To Monitor Reqs1WrittenProcToMonitorReqs

Form990 Schedule K Part VI Form990ScheduleKPartVI

FieldValueIRS element (for citing)
IdentifierFORM 990, SCHEDULE K, PART IV LINE 2CIdentifier
ExplanationARBITRAGE REBATE CALCULATION WAS PEFORMED AS OF APRIL 14, 2011 WHICH INDICATED NO REBATE AS BEING DUE.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 3THE ORGANIZATION HAS AN AGREEMENT WITH SMITH SENIOR LIVING TO OVERSEE AND MANAGE ITS DAY-TO-DAY OPERATIONS. THE INITIAL TERM OF THIS AGREEMENT WAS FOR A PERIOD OF ONE (1) YEAR. THIS AGREEMENT RENEWS ANNUALLY THEREAFTER UNLESS TERMINATED IN ACCORDANCE WITH OTHER TERMS AND CONDITIONS CONTAINED THEREIN. FURTHERMORE, CERTAIN SUBORDINATION AND DEFERRAL PROVISIONS APPLY IN CONNECTION WITH PAYMENT OF COMPENSATION TO SMITH SENIOR LIVING. UNDER THE TERMS OF THE AGREEMENT, THE ORGANIZATION MUST COMPENSATE SMITH SENIOR LIVING FOR MANAGEMENT SERVICES RENDERED. THE AGREEMENT ALSO CONTAINS A PROVISION TO COMPENSATE SMITH SENIOR LIVING FOR SUPPLEMENTAL SERVICES IT MAY PROVIDE ABOVE AND BEYOND THOSE ENUMERATED IN THE AGREEMENT. IN ADDITION, THE ORGANIZATION MUST PAY SMITH SENIOR LIVING AN ADDITIONAL SUM ON A MONTHLY BASIS AS REIMBURSEMENT FOR SMITH SENIOR LIVING'S OVERHEAD EXPENSES RELATED TO THE ORGANIZATION. EXPENSES INCURRED BY THE ORGANIZATION UNDER THIS AGREEMENT WERE $1,666,569.
FORM 990, PART VI, SECTION A, LINE 6SMITH VILLAGE HAS A SINGLE CLASS OF VOTING MEMBERS AND THE SOLE MEMBER OF THAT CLASS IS SMITH SENIOR LIVING, A RELATED ILLINOIS TAX-EXEMPT ORGANIZATION, WHICH SHALL CONTINUE FROM YEAR-TO-YEAR AS THE SOLE MEMBER OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7ATHE ORGANIZATION MUST HAVE APPROVAL OF ITS SOLE MEMBER, SMITH SENIOR LIVING, BEFORE ELECTING OR REMOVING ANY OF THE ORGANIZATION'S TRUSTEES AND OFFICERS.
FORM 990, PART VI, SECTION A, LINE 7BTHE ORGANIZATION SHALL NOT TAKE ANY OF THE FOLLOWING ACTIONS WITHOUT THE APPROVAL OF THE SOLE MEMBER: (1) AMENDMENT OF THE ARTICLES OF INCORPORATION OF THIS CORPORATION. (2) AMENDMENT OF THE BYLAWS OF THIS CORPORATION. (3) MERGER, CONSOLIDATION OR DISSOLUTION OF THIS CORPORATION. (4) THE CREATION OF ANY SUBSIDIARIES OR AFFILIATES OF THIS CORPORATION. (5) ADOPTION OF THE BUSINESS PLAN APPROVED ANNUALLY BY THE BOARD OF TRUSTEES OF THIS CORPORATION. (6) ADOPTION OF THE ANNUAL BUDGET APPROVED BY THIS CORPORATION AND ANY ACTIONS TAKEN BY THIS CORPORATION WHICH WOULD OR COULD INVOLVE EXPENDITURES WHICH EXCEED ONE HUNDRED AND TEN PERCENT (110%) OF THE APPROVED BUDGETED AMOUNTS FOR SUCH EXPENDITURES. (7) THE SELECTION OF BANKING AFFILIATIONS, ACCOUNTING FIRMS OR LEGAL COUNSEL, AS WELL AS APPROVAL OF THE ENGAGEMENT OF ANY CONSULTANTS NOT SPECIFICALLY PROVIDED IN AN APPROVED BUDGET. (8) THE SELECTION AND RETENTION OF THE EXECUTIVE DIRECTOR OF THIS CORPORATION. (9) THE MAKING OF CAPITAL EXPENDITURES OR SALE OF ANY CAPITAL ASSETS BY THIS CORPORATION IN EXCESS OF FIFTY THOUSAND DOLLARS ($50,000) UNLESS PROVIDED IN THE ANNUAL BUDGET. (10) THE SELECTION OF THE MANNER AND LOCATION OF INVESTMENT OF ANY FUNDS. (11) THE EXTENSION OF ANY LOANS BY OR ANY BORROWING BY THIS CORPORATION.
FORM 990, PART VI, SECTION B, LINE 11THE ORGANIZATION'S INTERNAL MANAGEMENT AND THE FINANCE COMMITTEE REVIEWS THE RETURN WITH ITS PAID TAX PREPARER. AFTER REVIEW, COPIES OF THE FULL FORM 990 ARE PRESENTED TO ALL TRUSTEES AND REVIEWED AT A BOARD MEETING PRIOR TO FILING THE RETURN WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CANNUALLY ALL TRUSTEES AND KEY PERSONNEL ARE REQUIRED TO COMPLETE A DISCLOSURE FOR CONFLICTS OF INTEREST. THE DISCLOSURES ARE REVIEWED BY THE CFO WHO DETERMINES IF A POTENTIAL OR ACTUAL CONFLICT OF INTEREST EXISTS. IF A POTENTIAL OR ACTUAL CONFLICT OF INTEREST EXISTS THE TRUSTEE IS REQUIRED TO RECUSE THEMSELVES FROM ANY VOTING, DELIBERATION, OR DECISION ON THE TRANSACTION AT THE BOARD LEVEL. FURTHERMORE, ALL VENDOR PAYMENT ACTIVITY IS REVIEWED BY THE CFO FOR VENDORS THAT MAY BE RELATED TO THE FILING ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 15THE ORGANIZATION RELIES ON SMITH SENIOR LIVING (SSL), A RELATED TAX-EXEMPT ORGANIZATION TO DETERMINE THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS. THE COMPENSATION COMMITTEE OF SSL EVALUATES AND ESTABLISHES COMPENSATION AND REVIEWS PROTOCOL FOR THE ORGANIZATION'S CEO AND CFO. ANNUAL COMPENSATION COMPARISONS TO INDUSTRY PROFESSIONALS ARE GATHERED AND REVIEWED ON AN ANNUAL BASIS. DECISIONS ARE DOCUMENTED IN THE COMPENSATION COMMITTEE MEETING MINUTES. THE LAST COMPENSATION REVIEW WAS COMPLETED IN 2012. THE CEO OF SSL DETERMINES THE ANNUAL COMPENSATION OF ALL OTHER OFFICERS, WITH THE EXCEPTION OF THE CFO, BY COMPARING THE COMPENSATION OF EACH OFFICER AND KEY EMPLOYEES TO PROFESSIONALS PERFORMING SIMILAR SERVICES IN SIMILAR INDUSTRIES ON AN ANNUAL BASIS. THE LAST COMPENSATION REVIEW WAS COMPLETED IN 2012.
FORM 990, PART VI, SECTION C, LINE 19FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC. GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICIES ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104, AND ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME.
FORM 990, PART XI, LINE 9:CHANGE IN VALUE OF ASSETS HELD IN PERPETUAL TRUST 1,468.CHANGES IN NET ASSETS OR FUND BALANCES:
AUDIT COMMITTEE AND FINANCIAL STATEMENT OVERSIGHTTHIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.FORM 990, PAGE 12, PART XII, LINE 2C

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
WJS - SMITH SENIOR LIVING
2320 WEST 113TH PLACECHICAGOIL60643364335178MANAGEMENTIL501(C)(3)LINE 11A, IN/A0
WJS - SMITH CROSSING
10501 EMILIE LANEORLAND PARKIL60467364333423CCRCIL501(C)(3)LINE 90SSL
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
SMITH SENIOR LIVING
E2065330COST
SMITH SENIOR LIVING
E4485918COST
SMITH SENIOR LIVING
C462252COST
SMITH SENIOR LIVING
M3866001COST
SMITH SENIOR LIVING
E421311COST

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